Enrolment Form

Part APersonal Details

First / Given Name*

First Name

Family name (Surname)*

Last Name

Title*

Mrs

Miss

USI Number*

Please provide USI in the spaces provided

Date of Birth*

Select Date ×

Sex*

Male

Female

Address of your usual residence.*

Write complete address here

Postal Address same as above?

Postal Address, if different*

Complete postal address here

Email*

Email Address

Emergency Contact Person*

Name and Relationship of Person

Phone*

Phone

Emergency Phone*

Phone

Location*

Note - Off site locations on request

Write here

Course Name*

QR Training

Course Name*

NSW / ARTC Training

Course Name*

QR / NSW / ARTC Training

Part CSupport Requirements (please specify if you require assistance with your learning)

Specification of required support

If you have a disability, impairment or long-term condition, what support do you require during training?

Write Here

Recognition of Prior Learning (RPL*

You may be eligible for RPL if you have learning or work experience. If you consider you have relevant learning or work experience or require further information give details below.

Yes

Part D

How did you hear about Swetha Training?*

Search Engine

Training.gov.au website

Transport for NSW website

Word of Mouth/other

Part E - Preferred Payment Method (please tick preferred method below). Note - Payment must be made before training day & medical assessment where applicable)

Direct Deposit To BSB and A/C # (Available on request)

Cash/Card - At our Burwood Office prior to day of training

Credit/Debit Card By phone Call: 1300 SWETHA

By Invoice (only approved ABN holders)

Part FStudent Declaration and Signature

Student Declaration and Signature

By signing & submitting this enrolment form I confirm to the following:

The information contained in this form is correct and complete. I agree to the terms and conditions which includes that classes may be rescheduled with at least 24hr notice (if insufficient enrolments are received for a specific class). Cancellations advised within 24hrs of the planned start time will incur a $30 administration fee. There is no refund for cancellations after course start time or for “no shows”. Individuals who are not recorded as competent following their first attempt at a course, will only have one additional opportunity to re-sit the training* and/or assessment without incurring a new course fee.

*(note-the opportunity to re-sit training only applies to one day courses)

Student Signature

Submission Date / Time

By submitting this form, you hereby agree to accept our Terms & Conditions. Your IP address 3.144.172.115 will be stored in our database.

Part APersonal Details

Part BStatistical Information / Government statistical purposes

Part CSupport Requirements (please specify if you require assistance with your learning)

Part D

Part E - Preferred Payment Method (please tick preferred method below). Note - Payment must be made before training day & medical assessment where applicable)

Part FStudent Declaration and Signature

Student Declaration and Signature

Student Signature

Your form has been submitted

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